Pregnancy Outcomes Using Assisted Reproductive Technology in Kidney Transplant Recipients

Infertility is common among those with kidney transplants, and pregnancy is associated with a high risk of adverse maternal and fetal outcomes. Little is known about the outcomes of pregnancy with assisted reproductive technology (ART) in women with kidney transplants.

This retrospective cohort study used data from the Transplant Pregnancy Registry International. Eligible participants were recipients of a kidney transplant between March 1968 and July 2022 who were aged 14 y or older at conception. Logistic regression analyses (adjusted for age at conception and race) were constructed to compare pregnancy outcomes with ART versus natural conception.

There were 130 pregnancies using ART in 77 kidney transplant recipients. ART pregnancies, as compared with natural conception pregnancies, were associated with a higher adjusted likelihood of hypertension during pregnancy (odds ratio [OR], 1.57; 95% confidence interval [CI], 1.06-2.32), higher adjusted likelihood of cesarean delivery (OR, 1.60; 95% CI, 1.02-2.51), and higher adjusted risk of preterm births <37 wk (OR, 2.07; 95% CI, 1.35-3.18). Pregnancies with ART, as compared with natural conception, had a lower median birth weight (2551 versus 2722.0 g), a lower median gestational age (36.0 versus 37.0 wk), and a higher proportion of neonatal deaths (4.4% versus 0.8%). No differences were observed in the adjusted likelihood of preeclampsia, gestational diabetes, miscarriages, live births, low birth weights, birth defects, or 2-y graft loss between ART and natural conception pregnancies.

ART pregnancies are associated with a higher risk of preterm births, hypertension during pregnancy, and cesarean delivery compared with naturally conceived pregnancies. The likelihood of live births and 2-y graft loss did not differ.